Osteogenic sarcoma of the jaws: factors influencing prognosis

Thirty cases of osteosarcoma of the jaws were reviewed (20 men and 10 women, mean age 34 years). Seventeen lesions occurred in the mandible and 13 in the maxilla. Swelling without pain was the most common presenting symptom. Thirteen lesions were initially misdiagnosed as odontogenic infections. Numbness as a presenting symptom was statistically associated with poor prognosis. Treatment included all combinations of surgery, chemotherapy and radiotherapy. Patients receiving chemotherapy with four or more agents showed a trend toward better survival with 71% alive and disease-free at the time of review. Patients' increasing age was statistically associated with decreased survival. The average age of survivors was 27 years and nonsurvivors, 40 years. Older patients suffered more local recurrences which, in all but one case, resulted in mortality. Expectedly, clear surgical margins correlated statistically with improved survival. With margins of less than 5 mm, 27% of patients were alive and disease-free as compared to 62% with surgical margins greater than 5 mm. The importance of early diagnosis, definitive surgical treatment and aggressive adjuvant chemotherapy is demonstrated. The Proportional Hazards Regression model was employed to evaluate the statistical significance of a variety of factors on disease-free and overall survival.